Senior Provider Relations Professional

Profile

Description

The Senior Provider Relations Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Relations Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications


3 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience

Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies

Demonstrated ability to manage multiple projects and meet deadlines

Strong communication and presentation skills with ability to effectively communicate with all levels of the organization, internally and externally

Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Bachelor's Degree

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Comprehensive knowledge of Medicare policies, processes and procedures


Additional Information

This is a remote position to be located within the State of California. As the environment changes and we return to normal business operations, this person will be required to travel to provider offices within the region up to 50% of the time.

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact **** for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact **** to validate the request.

California Residents

If you are a California resident and would like to review our California Consumer Privacy Act (CCPA) Policy click here:

CA Resident Privacy Policy

Company info

Sign Up Now - MiamiCrossing.com